Attention Networks for Personalized Mealtime Insulin Dosing in People with Type 1 Diabetes

Calculating mealtime insulin doses poses a significant challenge for individuals with Type 1 Diabetes (T1D). Doses should perfectly compensate for expected post-meal glucose excursions, requiring a profound understanding of the individual's insulin sensitivity and the meal macronutrients'. Usually, people rely on intuition and experience to develop this understanding. In this work, we demonstrate how a reinforcement learning agent, employing a self-attention encoder network, can effectively mimic and enhance this intuitive process. Trained on 80 virtual subjects from the FDA-approved UVA/Padova T1D adult cohort and tested on twenty, self-attention demonstrates superior performance compared to other network architectures. Results reveal a significant reduction in glycemic risk, from 16.5 to 9.6 in scenarios using sensor-augmented pump and from 9.1 to 6.7 in scenarios using automated insulin delivery. This new paradigm bypasses conventional therapy parameters, offering the potential to simplify treatment and promising improved quality of life and glycemic outcomes for people with T1D.

Using Reinforcement Learning to Simplify Mealtime Insulin Dosing for People with Type 1 Diabetes: In-Silico Experiments

People with type 1 diabetes (T1D) struggle to calculate the optimal insulin dose at mealtime, especially when under multiple daily injections (MDI) therapy. Effectively, they will not always perform rigorous and precise calculations, but occasionally, they might rely on intuition and previous experience. Reinforcement learning (RL) has shown outstanding results in outperforming humans on tasks requiring intuition and learning from experience. In this work, we propose an RL agent that recommends the optimal meal-accompanying insulin dose corresponding to a qualitative meal (QM) strategy that does not require precise carbohydrate counting (CC) (e.g., a usual meal at noon.). The agent is trained using the soft actor-critic approach and comprises long short-term memory (LSTM) neurons. For training, eighty virtual subjects (VS) of the FDA-accepted UVA/Padova T1D adult population were simulated using MDI therapy and QM strategy. For validation, the remaining twenty VS were examined in 26-week scenarios, including intra- and inter-day variabilities in glucose. \textit{In-silico} results showed that the proposed RL approach outperforms a baseline run-to-run approach and can replace the standard CC approach. Specifically, after 26 weeks, the time-in-range ($70-180$mg/dL) and time-in-hypoglycemia ($<70$mg/dL) were $73.1\pm11.6$% and $ 2.0\pm 1.8$% using the RL-optimized QM strategy compared to $70.6\pm14.8$% and $ 1.5\pm 1.5$% using CC. Such an approach can simplify diabetes treatment, resulting in improved quality of life and glycemic outcomes.